The Heart Institute at Regional Medical Center Bayonet Point continues its Tuesday Tutorials programming commemorating National Heart Month through March with “When Do You Need Open Heart Surgery & What...

Iron: Are You Getting Enough?

Lethargy. Fatigue. Listlessness. Busy people attribute it to stress. Others are convinced that they need more sleep. But one possible cause is
iron-deficiency anemia.

"I'm always tired, but I've gotten used to it," says Kathy, 49, an administrative assistant at a busy health clinic. "I come home from work, cook dinner, usually clean or do laundry. And I'm wiped out. Maybe I should get to sleep earlier, but it never seems to work out that way."

"I thought I was just run down and stressed out," says Julie, 28, a graduate student who admits that she often burns the midnight oil. "I just attributed everything to stress. I had no idea there was a medical cause."

Kathy and Julie both have iron-deficiency anemia. It is a condition that develops because the body's stores of iron are slowly depleted. Women of childbearing age are at risk for this condition because of the blood loss during menstruation. In addition, some women do not get enough iron in their diets to make up for these losses.

Should You Be Concerned About Iron-deficiency Anemia?

Menstruating women lose a significant amount of blood every month. Iron escapes right along with it. Unless iron is replaced, these monthly losses can drain stores over time. While premenopausal women need more iron than men, they generally eat less. This complicates the challenge of getting enough iron from foods.

People who take certain medications, like antacids, H-2 blockers, proton pump inhibitors, chronic use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, or zinc or magnesium supplements

Adolescents, especially girls

Why Is Iron So Important?

Iron is the central component of
heme. Heme is a molecule used to build
hemoglobin, the oxygen-carrying part of red blood cells.
Oxygen is used by your body to help make energy. When iron stores are low, the body cannot make enough hemoglobin. There is then less oxygen to help generate energy. Iron also allows the normal functioning of the immune system, the production of collagen (wound healing), and the formation of amino acids, which are the backbone of proteins.

As levels of hemoglobin in the blood decrease, the symptoms of anemia start to appear.

Fatigue

Weakness

Apathy or irritability

Headaches

Pallor

Lowered resistance to infection

May feel cold

Wounds may take longer to heal

Finger nails may become spoon shaped

Anemia comes on slowly, so many people do not realize that they have it. Is it possible to have symptoms of iron deficiency without being anemic?
Slight iron deficiency, too mild to cause anemia, may still cause symptoms, such as fatigue and decreased exercise capacity.

How Much Iron Do You Need?

The following table shows the Office of Dietary Supplements' Recommended Dietary Allowance (RDA) for iron:

AgeMales (mg/day)Females (mg/dayPregnancy (mg/day)Lactation (mg/day)

7 to 12 months1111––

1 to 3 years77––

4 to 8 years1010––

9 to 13 years88––

14 to 18 years11152710

19 to 50 years818279

51 years and older88––

Do not take iron just because you feel tired. Make sure to get tested to see whether you are indeed deficient. With iron, more is definitely not better. Excessive iron intake can be harmful.

Iron and Your Diet

If you have been diagnosed with iron-deficiency, your doctor has probably advised you to include more iron in your diet. If anemia is severe, an iron supplement, such as ferrous sulfate, may be prescribed. Knowing which foods are rich in iron is the first step toward boosting your iron stores. Take a look at the list below to put more iron on your menu.

When adding iron to your diet, keep in mind that there are different forms of this mineral:

Heme iron—efficiently absorbed by the body, found in meats and animal products

Nonheme iron—may be less well absorbed by the body, found in plant sources

Nutritionists have traditionally grouped meat, fish, and poultry together as the best sources of heme iron. Liver has the highest heme iron content. Other good sources include beef, lamb, pork, turkey, chicken and eggs.

Eating for Energy

It is not enough to know where iron is lurking. You also have to get it into your system. This is somewhat more difficult for vegetarians since all nonmeat forms of iron are nonheme, and therefore less well absorbed. But, it is certainly not impossible. Here are some tips:

Choose iron-rich foods.—Lean meats, fish, and poultry are still the best iron sources for meat eaters. For those of you who are not willing to eat a steak once a week, foods like beans and legumes, greens, whole grains, and dried fruits will provide iron, albeit in a less absorbable, nonheme form.

Remember that little things add up.—Choose iron-enriched rice, pasta, and breads; switch to an iron-fortified cereal for breakfast; add dark (blackstrap) molasses or raisins when baking. It may sound like an old wives' tale, but cooking in an iron skillet, especially with high-acid foods like tomatoes, can contribute a little extra iron, too.

Supplement with ferrous sulfate or a multivitamin.—For those of us who simply cannot get enough iron from foods, supplementation may be a viable alternative. Talk to your doctor first, though, and find out what supplement is right for you.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.